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Parker M, Kazemi F, Krishnakumar A, Horowitz MA, Myneni S, Liu A, Schreck KC, Lucas CHG, Mukherjee D. Availability and utilization of molecular testing for primary central nervous system tumors among US hospitals. J Neuropathol Exp Neurol 2024; 83:579-585. [PMID: 38687613 PMCID: PMC11187421 DOI: 10.1093/jnen/nlae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Advanced molecular testing has increasingly become an integral component for accurate diagnosis of central nervous system (CNS) tumors. We sought to establish the current state of molecular testing availability and approaches for the diagnosis of CNS tumors in US hospitals that conduct high volumes of CNS tumor resections. We distributed a 16-item survey inquiring about molecular testing approaches for CNS tumors to 115 neuropathologists at US hospitals with neurosurgery residency programs. Thirty-five neuropathologists (30.4%) responded to the survey, all of whom indicated their institutions perform molecular testing on CNS tumor tissue. The most commonly offered tests were MGMT methylation profiling and next-generation sequencing. Fourteen respondents (40%) indicated that their institution is able to test for and report all of the molecular alterations included in our survey. Nine (25.7%) respondents indicated that molecular testing is performed as standard of care for all patients with resected CNS tumors. Our results suggest that even in academic hospitals with a high volume of CNS tumor resections, molecular testing for these tumors is limited. Continued initiatives are necessary to expand the availability of molecular testing for CNS tumors to ensure diagnostic accuracy and guide targeted therapy.
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Affiliation(s)
- Megan Parker
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Asha Krishnakumar
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melanie A Horowitz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saket Myneni
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abby Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karisa C Schreck
- Department of Neurology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Anderson EC, DiPalazzo J, Lucas FL, Hall MJ, Antov A, Helbig P, Bourne J, Graham L, Gaitor L, Lu-Emerson C, Bradford LS, Inhorn R, Sinclair SJ, Brooks PL, Thomas CA, Rasmussen K, Han PKJ, Liu ET, Rueter J. Genome-matched treatments and patient outcomes in the Maine Cancer Genomics Initiative (MCGI). NPJ Precis Oncol 2024; 8:67. [PMID: 38461318 PMCID: PMC10924947 DOI: 10.1038/s41698-024-00547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
Genomic tumor testing (GTT) is an emerging technology aimed at identifying variants in tumors that can be targeted with genomically matched drugs. Due to limited resources, rural patients receiving care in community oncology settings may be less likely to benefit from GTT. We analyzed GTT results and observational clinical outcomes data from patients enrolled in the Maine Cancer Genomics Initiative (MCGI), which provided access to GTTs; clinician educational resources; and genomic tumor boards in community practices in a predominantly rural state. 1603 adult cancer patients completed enrollment; 1258 had at least one potentially actionable variant identified. 206 (16.4%) patients received a total of 240 genome matched treatments, of those treatments, 64% were FDA-approved in the tumor type, 27% FDA-approved in a different tumor type and 9% were given on a clinical trial. Using Inverse Probability of Treatment Weighting to adjust for baseline characteristics, a Cox proportional hazards model demonstrated that patients who received genome matched treatment were 31% less likely to die within 1 year compared to those who did not receive genome matched treatment (HR: 0.69; 95% CI: 0.52-0.90; p-value: 0.006). Overall, GTT through this initiative resulted in levels of genome matched treatment that were similar to other initiatives, however, clinical trials represented a smaller share of treatments than previously reported, and "off-label" treatments represented a greater share. Although this was an observational study, we found evidence for a potential 1-year survival benefit for patients who received genome matched treatments. These findings suggest that when disseminated and implemented with a supportive infrastructure, GTT may benefit cancer patients in rural community oncology settings, with further work remaining on providing genome-matched clinical trials.
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Affiliation(s)
- Eric C Anderson
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - John DiPalazzo
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - F Lee Lucas
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | | | | | | | | | | | | | | | - Leslie S Bradford
- Maine Medical Partners Women's Health, Gynecologic Oncology, Scarborough, ME, USA
| | - Roger Inhorn
- PenBay Medical Center Oncology, Rockport, ME, USA
| | | | | | | | | | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- National Cancer Institute, Bethesda, MD, USA
| | - Edison T Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
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Xu B, Viswanathan K, Ahadi MS, Ahmadi S, Alzumaili B, Bani MA, Baudin E, Behrman DB, Capelletti M, Chau NG, Chiarucci F, Chou A, Clifton-Bligh R, Coluccelli S, de Biase D, De Leo A, Dogan S, Fagin JA, Fuchs TL, Glover AR, Hadoux J, Lacroix L, Lamartina L, Lubin DJ, Luxford C, Magliocca K, Maloberti T, Mohanty AS, Najdawi F, Nigam A, Papachristos AJ, Repaci A, Robinson B, Scoazec JY, Shi Q, Sidhu S, Solaroli E, Sywak M, Tuttle RM, Untch B, Barletta JA, Al Ghuzlan A, Gill AJ, Ghossein R, Tallini G, Ganly I. Association of the Genomic Profile of Medullary Thyroid Carcinoma with Tumor Characteristics and Clinical Outcomes in an International Multicenter Study. Thyroid 2024; 34:167-176. [PMID: 37842841 PMCID: PMC10884546 DOI: 10.1089/thy.2023.0279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Purpose: The prognostic importance of RET and RAS mutations and their relationship to clinicopathologic parameters and outcomes in medullary thyroid carcinoma (MTC) need to be clarified. Experimental Design: A multicenter retrospective cohort study was performed utilizing data from 290 patients with MTC. The molecular profile was determined and associations were examined with clinicopathologic data and outcomes. Results: RET germ line mutations were detected in 40 patients (16.3%). Somatic RET and RAS mutations occurred in 135 (46.9%) and 57 (19.8%) patients, respectively. RETM918T was the most common somatic RET mutation (n = 75). RET somatic mutations were associated with male sex, larger tumor size, advanced American Joint Committee Cancer (AJCC) stage, vascular invasion, and high International Medullary Thyroid Carcinoma Grading System (IMTCGS) grade. When compared with other RET somatic mutations, RETM918T was associated with younger age, AJCC (eighth edition) IV, vascular invasion, extrathyroidal extension, and positive margins. RET somatic or germ line mutations were significantly associated with reduced distant metastasis-free survival on univariate analysis, but there were no significant independent associations on multivariable analysis, after adjusting for tumor grade and stage. There were no significant differences in outcomes between RET somatic and RET germ line mutations, or between RETM918T and other RET mutations. Other recurrent molecular alterations included TP53 (4.2%), ARID2 (2.9%), SETD2 (2.9%), KMT2A (2.9%), and KMT2C (2.9%). Among them, TP53 mutations were associated with decreased overall survival (OS) and disease-specific survival (DSS), independently of tumor grade and AJCC stage. Conclusions: RET somatic mutations were associated with high-grade, aggressive primary tumor characteristics, and decreased distant metastatic-free survival but this relationship was not significant after accounting for tumor grade and disease stage. RETM918T was associated with aggressive primary tumors but was not independently associated with clinical outcomes. TP53 mutation may represent an adverse molecular event associated with decreased OS and DSS in MTC, but its prognostic value needs to be confirmed in future studies.
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Affiliation(s)
- Bin Xu
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mahsa S Ahadi
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sara Ahmadi
- Division of Endocrinology and Metabolism, Department of Medicine; Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Bayan Alzumaili
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Mohamed-Amine Bani
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Eric Baudin
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - David Blake Behrman
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Marzia Capelletti
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole G Chau
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Federico Chiarucci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Angela Chou
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sara Coluccelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology; Bologna, Italy
| | - Antonio De Leo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Snjezana Dogan
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - James A Fagin
- Division of Specialized Medicine; New York, New York, USA
| | - Talia L Fuchs
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony Robert Glover
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Julien Hadoux
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Ludovic Lacroix
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Livia Lamartina
- Département d'imagerie, Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Catherine Luxford
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Kelly Magliocca
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Thais Maloberti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Abhinita S Mohanty
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Fedaa Najdawi
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Aradhya Nigam
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander James Papachristos
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care; IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Bruce Robinson
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jean-Yves Scoazec
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stan Sidhu
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Erica Solaroli
- Endocrinology Unit, Azienda USL di Bologna, Bologna, Italy
| | - Mark Sywak
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Brian Untch
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justine A Barletta
- Department of Pathology; Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Abir Al Ghuzlan
- Medical Pathology and Biology Department; Service d'oncologie endocrinienne; Gustave Roussy Campus Cancer, Villejuif, France
| | - Anthony J Gill
- Royal North Shore Hospital and Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research; Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine; New York, New York, USA
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center; Bologna, Italy
| | - Ian Ganly
- Department of Surgery; Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Cerretti G, Padovan M, Guerriero A, Maccari M, Bosio A, Caccese M, Cella E, Pintacuda G, Librizzi G, Lombardi G. Prolonged response to entrectinib in an adult patient with recurrent glioblastoma harboring a GOPC::ROS1 fusion. Neurooncol Adv 2024; 6:vdae077. [PMID: 38845690 PMCID: PMC11154136 DOI: 10.1093/noajnl/vdae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Affiliation(s)
- Giulia Cerretti
- PhD course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
| | - Marta Padovan
- PhD course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
| | - Angela Guerriero
- Surgical Pathology Unit, University Hospital of Padova, Padova, Italy
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
- School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Alberto Bosio
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
- School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
| | - Eugenia Cella
- Oncology 2, IRCCS Ospedale San Martino, Genova, Italy
| | | | - Giovanni Librizzi
- Department of Neuroscience, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
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Ghanem P, Fatteh M, Kamson DO, Balan A, Chang M, Tao J, Blakeley J, Canzoniero J, Grossman SA, Marrone K, Schreck KC, Anagnostou V. Druggable genomic landscapes of high-grade gliomas. Front Med (Lausanne) 2023; 10:1254955. [PMID: 38143440 PMCID: PMC10749203 DOI: 10.3389/fmed.2023.1254955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 12/26/2023] Open
Abstract
Background Despite the putatively targetable genomic landscape of high-grade gliomas, the long-term survival benefit of genomically-tailored targeted therapies remains discouraging. Methods Using glioblastoma (GBM) as a representative example of high-grade gliomas, we evaluated the clonal architecture and distribution of hotspot mutations in 388 GBMs from the Cancer Genome Atlas (TCGA). Mutations were matched with 54 targeted therapies, followed by a comprehensive evaluation of drug biochemical properties in reference to the drug's clinical efficacy in high-grade gliomas. We then assessed clinical outcomes of a cohort of patients with high-grade gliomas with targetable mutations reviewed at the Johns Hopkins Molecular Tumor Board (JH MTB; n = 50). Results Among 1,156 sequence alterations evaluated, 28.6% represented hotspots. While the frequency of hotspot mutations in GBM was comparable to cancer types with actionable hotspot alterations, GBMs harbored a higher fraction of subclonal mutations that affected hotspots (7.0%), compared to breast cancer (4.9%), lung cancer (4.4%), and melanoma (1.4%). In investigating the biochemical features of targeted therapies paired with recurring alterations, we identified a trend toward higher lipid solubility and lower IC50 in GBM cell lines among drugs with clinical efficacy. The drugs' half-life, molecular weight, surface area and binding to efflux transporters were not associated with clinical efficacy. Among the JH MTB cohort of patients with IDH1 wild-type high-grade gliomas who received targeted therapies, trametinib monotherapy or in combination with dabrafenib conferred radiographic partial response in 75% of patients harboring BRAF or NF1 actionable mutations. Cabozantinib conferred radiographic partial response in two patients harboring a MET and a PDGFRA/KDR amplification. Patients with IDH1 wild-type gliomas that harbored actionable alterations who received genotype-matched targeted therapy had longer progression-free (PFS) and overall survival (OS; 7.37 and 14.72 respectively) than patients whose actionable alterations were not targeted (2.83 and 4.2 months respectively). Conclusion While multiple host, tumor and drug-related features may limit the delivery and efficacy of targeted therapies for patients with high-grade gliomas, genotype-matched targeted therapies confer favorable clinical outcomes. Further studies are needed to generate more data on the impact of biochemical features of targeted therapies on their clinical efficacy for high-grade gliomas.
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Affiliation(s)
- Paola Ghanem
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Maria Fatteh
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Olayinka Kamson
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Archana Balan
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Chang
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jessica Tao
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jaishri Blakeley
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jenna Canzoniero
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stuart A. Grossman
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kristen Marrone
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karisa C. Schreck
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Valsamo Anagnostou
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Johns Hopkins Molecular Tumor Board, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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6
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Felistia Y, Wen PY. Molecular Profiling and Targeted Therapies in Gliomas. Curr Neurol Neurosci Rep 2023; 23:627-636. [PMID: 37812369 DOI: 10.1007/s11910-023-01299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE OF REVIEW Molecular profiling enables the evaluation of genetic alterations for the diagnosis and classification of gliomas and the selection of appropriate therapies. This review summarizes the current role of molecular profiling and targeted therapies for gliomas. RECENT FINDINGS Molecular profiling is an integral part of the 2021 WHO classification of gliomas. Progress in the development of targeted therapies remains limited due to many factors including the presence of the blood-brain barrier and issues of tumor heterogeneity. Nonetheless, advances have been made with the IDH1/2 inhibitor vorasidenib for IDH-mutant grade 2 gliomas, the combination of dabrafenib and trametinib for BRAFV600E mutated gliomas, and the therapies for subsets of patients with fusions and H3K27M-altered diffuse midline gliomas. While there has been progress in the use of molecular profiling for the classification and treatment of gliomas, much work remains for targeted therapies to realize their potential.
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Affiliation(s)
- Yuli Felistia
- Neuro-Oncology Division, National Brain Center Hospital, Jakarta, Indonesia
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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7
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Peruzzi P, Dominas C, Fell G, Bernstock JD, Blitz S, Mazzetti D, Zdioruk M, Dawood HY, Triggs DV, Ahn SW, Bhagavatula SK, Davidson SM, Tatarova Z, Pannell M, Truman K, Ball A, Gold MP, Pister V, Fraenkel E, Chiocca EA, Ligon KL, Wen PY, Jonas O. Intratumoral drug-releasing microdevices allow in situ high-throughput pharmaco phenotyping in patients with gliomas. Sci Transl Med 2023; 15:eadi0069. [PMID: 37672566 PMCID: PMC10754230 DOI: 10.1126/scitranslmed.adi0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
The lack of reliable predictive biomarkers to guide effective therapy is a major obstacle to the advancement of therapy for high-grade gliomas, particularly glioblastoma (GBM), one of the few cancers whose prognosis has not improved over the past several decades. With this pilot clinical trial (number NCT04135807), we provide first-in-human evidence that drug-releasing intratumoral microdevices (IMDs) can be safely and effectively used to obtain patient-specific, high-throughput molecular and histopathological drug response profiling. These data can complement other strategies to inform the selection of drugs based on their observed antitumor effect in situ. IMDs are integrated into surgical practice during tumor resection and remain in situ only for the duration of the otherwise standard operation (2 to 3 hours). None of the six enrolled patients experienced adverse events related to the IMD, and the exposed tissue was usable for downstream analysis for 11 out of 12 retrieved specimens. Analysis of the specimens provided preliminary evidence of the robustness of the readout, compatibility with a wide array of techniques for molecular tissue interrogation, and promising similarities with the available observed clinical-radiological responses to temozolomide. From an investigational aspect, the amount of information obtained with IMDs allows characterization of tissue effects of any drugs of interest, within the physiological context of the intact tumor, and without affecting the standard surgical workflow.
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Affiliation(s)
- Pierpaolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Christine Dominas
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA
| | - Geoffrey Fell
- Department of Data Science, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Sarah Blitz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Debora Mazzetti
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Mykola Zdioruk
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Hassan Y. Dawood
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Daniel V. Triggs
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Sebastian W. Ahn
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA
| | - Sharath K. Bhagavatula
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA
| | - Shawn M. Davidson
- Lewis-Sigler Institute of Integrative Genomics, Princeton University, Princeton, NJ 08540, USA
| | - Zuzana Tatarova
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA
| | - Michael Pannell
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Kyla Truman
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Anna Ball
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Maxwell P. Gold
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Veronika Pister
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ernest Fraenkel
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
| | - E. Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Keith L. Ligon
- Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Patrick Y. Wen
- Division of Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA
| | - Oliver Jonas
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA
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8
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Padovan M, Maccari M, Bosio A, De Toni C, Vizzaccaro S, Cestonaro I, Corrà M, Caccese M, Cerretti G, Zagonel V, Lombardi G. Actionable molecular alterations in newly diagnosed and recurrent IDH1/2 wild-type glioblastoma patients and therapeutic implications: a large mono-institutional experience using extensive next-generation sequencing analysis. Eur J Cancer 2023; 191:112959. [PMID: 37481865 DOI: 10.1016/j.ejca.2023.112959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Next-generation sequencing (NGS) panels enable the identification of alterations in cancer-related genes. This may guide a molecularly targeted strategy for the treatment of glioblastoma (GBM). MATERIAL AND METHODS We retrospectively analysed data obtained using FoundationOne®CDx in a large cohort of IDH1/2 wild-type GBM. We aimed to 1) identify potentially actionable molecular alterations at diagnosis and/or recurrence based on ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) defined categories of targetability, 2) understand the clinical implications of NGS in terms of access to and activity of targeted therapies. RESULTS In 442 samples, an NGS profile was available in 98.2%. The median time from diagnosis to NGS profiling was 7.4 months (interquartile range (IQR): 3.4-13.2). Although about half of the patients had at least one actionable molecular alteration, only 3.4% of them were classified as ESCAT IB-IC and 6.7% as ESCAT IIB. Only 36 patients (10.5%) received personalised treatment in clinical trials or as off-label/compassionate use from second-line (median line 3). Most patients did not receive targeted therapy due to clinical deterioration/death (49.6%). Patients treated with dabrafenib/trametinib (9 patients) had the highest disease control rate of 77% and an objective response rate of 22%, with a median progression-free survival (PFS) of 5.2 months. No complete/partial responses were seen with the other regimens. 4/9 (44.4%) patients on anti-BRAF/anti-MEK, 2/4 patients (50%) on erdafitinib and 1/1 patient on capmatinib had a PFS ratio > 1.3. One recurrent GBM patient with ROS1-GOCP fusion maintained a complete response for 11.3 months on entrectinib. CONCLUSIONS Our study demonstrated the feasibility of NGS in GBM samples. As the number of clinically relevant targets was limited and only a small group of GBM patients were treated with targeted therapy, NGS testing should be performed in the context of clinical trials. Our results support the activity of anti-BRAF/anti-MEK, while for the other agents prospective study results are needed to draw solid conclusions.
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Affiliation(s)
- Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; PhD course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alberto Bosio
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Chiara De Toni
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Salvatore Vizzaccaro
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ilaria Cestonaro
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Martina Corrà
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; PhD course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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9
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Porter AB, Wen PY, Polley MYC. Molecular Profiling in Neuro-Oncology: Where We Are, Where We're Heading, and How We Ensure Everyone Can Come Along. Am Soc Clin Oncol Educ Book 2023; 43:e389322. [PMID: 37167580 DOI: 10.1200/edbk_389322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Advances in molecular profiling have led to improved understanding of glioma heterogeneity. Results have been used to inform diagnostic classification and targeted treatment strategies. Validation of these tests is necessary in the development of biomarkers that can aid in treatment decision, allowing for personalized medicine in neuro-oncologic diseases. Although not all populations have benefitted equally from awareness of and access to testing, opportunities arise regarding incorporating this testing into the standard of care for patients with glioma.
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Affiliation(s)
- Alyx B Porter
- Mayo Clinic and Mayo Clinic Alix School of Medicine, Phoenix, AZ
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mei-Yin C Polley
- University of Chicago Biological Sciences, Department of Public Health Sciences, Chicago, IL
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10
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Rahman R, Polley MYC, Alder L, Brastianos PK, Anders CK, Tawbi HA, Mehta M, Wen PY, Geyer S, de Groot J, Zadeh G, Piantadosi S, Galanis E, Khasraw M. Current drug development and trial designs in neuro-oncology: report from the first American Society of Clinical Oncology and Society for Neuro-Oncology Clinical Trials Conference. Lancet Oncol 2023; 24:e161-e171. [PMID: 36990614 PMCID: PMC10401610 DOI: 10.1016/s1470-2045(23)00005-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/11/2022] [Accepted: 01/05/2023] [Indexed: 03/29/2023]
Abstract
Successful drug development for people with cancers of the CNS has been challenging. There are multiple barriers to successful drug development including biological factors, rarity of the disease, and ineffective use of clinical trials. Based upon a series of presentations at the First Central Nervous System Clinical Trials Conference hosted by the American Society of Clinical Oncology and the Society for Neuro-Oncology, we provide an overview on drug development and novel trial designs in neuro-oncology. This Review discusses the challenges of therapeutic development in neuro-oncology and proposes strategies to improve the drug discovery process by enriching the pipeline of promising therapies, optimising trial design, incorporating biomarkers, using external data, and maximising efficacy and reproducibility of clinical trials.
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Affiliation(s)
- Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mei-Yin C Polley
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Laura Alder
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Priscilla K Brastianos
- Massachusetts General Hospital, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carey K Anders
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Minesh Mehta
- Miami Cancer Institute, Baptist Hospital, Miami, FL, USA
| | - Patrick Y Wen
- Centre for Neuro-Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Susan Geyer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - John de Groot
- University of California San Francisco Brain Tumor Center, San Francisco, CA, USA
| | - Gelareh Zadeh
- Department of Neurological Surgery University of Toronto, Toronto, ON, Canada
| | - Steven Piantadosi
- Department of Surgery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Evanthia Galanis
- Department of Oncology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Mustafa Khasraw
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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11
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Deng D, Hammoudeh L, Youssef G, Chen YH, Shin KY, Lim-Fat MJ, McFaline-Figueroa JR, Chukwueke UN, Tanguturi S, Reardon DA, Lee EQ, Nayak L, Bi WL, Arnaout O, Ligon KL, Wen PY, Rahman R. Evaluating hematologic parameters in newly diagnosed and recurrent glioblastoma: Prognostic utility and clinical trial implications of myelosuppression. Neurooncol Adv 2023; 5:vdad083. [PMID: 37554224 PMCID: PMC10406420 DOI: 10.1093/noajnl/vdad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) patients are treated with radiation therapy, chemotherapy, and corticosteroids, which can cause myelosuppression. To understand the relative prognostic utility of blood-based biomarkers in GBM and its implications for clinical trial design, we examined the incidence, predictors, and prognostic value of lymphopenia, neutrophil-to-lymphocyte ratio (NLR), and platelet count during chemoradiation (CRT) and recurrence. METHODS This cohort study included 764 newly diagnosed glioblastoma patients treated from 2005 to 2019 with blood counts prior to surgery, within 6 weeks of CRT, and at first recurrence available for automatic extraction from the medical record. Logistic regression was used to evaluate exposures and Kaplan-Meier was used to evaluate outcomes. RESULTS Among the cohort, median age was 60.3 years; 87% had Karnofsky performance status ≥ 70, 37.5% had gross total resection, and 90% received temozolomide (TMZ). During CRT, 37.8% (248/656) of patients developed grade 3 or higher lymphopenia. On multivariable analysis (MVA), high NLR during CRT remained an independent predictor for inferior survival (Adjusted Hazard Ratio [AHR] = 1.57, 95% CI = 1.14-2.15) and shorter progression-free survival (AHR = 1.42, 95% CI = 1.05-1.90). Steroid use was associated with lymphopenia (OR = 2.66,1.20-6.00) and high NLR (OR = 3.54,2.08-6.11). Female sex was associated with lymphopenia (OR = 2.33,1.03-5.33). At first recurrence, 28% of patients exhibited grade 3 or higher lymphopenia. High NLR at recurrence was associated with worse subsequent survival on MVA (AHR = 1.69, 95% CI = 1.25-2.27). CONCLUSIONS High NLR is associated with worse outcomes in newly diagnosed and recurrent glioblastoma. Appropriate eligibility criteria and accounting and reporting of blood-based biomarkers are important in the design and interpretation of newly diagnosed and recurrent glioblastoma trials.
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Affiliation(s)
- Davy Deng
- Massachusetts Institute of Technology, Harvard University, Boston, Massachusetts, USA
| | - Lubna Hammoudeh
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Gilbert Youssef
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Yu-Hui Chen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts¸USA
| | - Kee-Young Shin
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Ugonma N Chukwueke
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Shyam Tanguturi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - David A Reardon
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Eudocia Q Lee
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Lakshmi Nayak
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women’s Hospital, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts¸ USA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
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12
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Abstract
Glioblastoma is the most aggressive primary brain tumor with a poor prognosis. The 2021 WHO CNS5 classification has further stressed the importance of molecular signatures in diagnosis although therapeutic breakthroughs are still lacking. In this review article, updates on the current and novel therapies in IDH-wildtype GBM will be discussed.
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Affiliation(s)
- Jawad M Melhem
- Division of Neurology, Department of Medicine, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - James R Perry
- Division of Neurology, Department of Medicine, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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13
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Aquilanti E, Wen PY. Current therapeutic options for glioblastoma and future perspectives. Expert Opin Pharmacother 2022; 23:1629-1640. [DOI: 10.1080/14656566.2022.2125302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Elisa Aquilanti
- Division of Neuro Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215
| | - Patrick Y. Wen
- Division of Neuro Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215
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14
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Loss of H3K27me3 in WHO grade 3 meningioma. Brain Tumor Pathol 2022; 39:200-209. [PMID: 35678886 DOI: 10.1007/s10014-022-00436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 01/08/2023]
Abstract
Immunohistochemical quantification of H3K27me3 was reported to distinguish meningioma patients with an unfavorable prognosis but is not yet established as a prognostic biomarker within WHO grade 3 meningiomas. We studied H3K27me3 loss in a series of biopsies from primary and secondary malignant meningioma to validate its prognostic performance and describe if loss of H3K27me3 occurs during malignant transformation. Two observers quantified H3K27me3 status as "complete loss", < 50% and > 50% stained cells in 110 tumor samples from a population-based consecutive cohort of 40 WHO grade 3 meningioma patients. We found no difference in overall survival (OS) in patients with > 50% H3K27me3 retention compared to < 50% in the cohort of patients with WHO grade 3 meningioma (Wald test p = 0.5). H3K27me3 staining showed heterogeneity in full section tumor slides while staining of the Barr body and peri-necrotic cells complicated quantification further. H3K27me3 expression differed without a discernible pattern between biopsies from repeated surgeries of meningioma recurrences. In conclusion, our results were not compatible with a systematic pattern of immunohistochemical H3K27me3 loss being associated with OS or malignant transformation of meningiomas and did not support H3K27me3 loss as a useful immunohistochemical biomarker within grade 3 meningiomas due to staining-specific challenges in quantification.
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15
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Next generation sequencing in adult patients with glioblastoma in Switzerland: a multi-centre decision analysis. J Neurooncol 2022; 158:359-367. [PMID: 35486306 DOI: 10.1007/s11060-022-04022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Glioblastoma is the most common malignant primary brain tumour in adults and driven by various genomic alterations. Next generation sequencing (NGS) provides timely information about the genetic landscape of tumours and might detect targetable mutations. To date, differences exist in the application and NGS assays used as it remains unclear to what extent these variants may affect clinical decision making. In this survey-based study, we investigated the use of NGS in adult patients with glioblastoma in Switzerland. METHODS All eight primary care centres for Neuro-Oncology in Switzerland participated in this survey. The NGS assays used as well as the criteria for the application of NGS in newly diagnosed glioblastoma were investigated. Decision trees were analysed for consensus and discrepancies using the objective consensus methodology. RESULTS Seven out of eight centres perform NGS in patients with newly diagnosed glioblastoma using custom made or commercially available assays. The criteria most relevant to decision making were age, suitability of standard treatment and fitness. NGS is most often used in fitter patients under the age of 60 years who are not suitable for standard therapy, while it is rarely performed in patients in poor general health. CONCLUSION NGS is frequently applied in glioblastomas in adults in Neuro-Oncology centres in Switzerland despite seldom changing the course of treatment to date.
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16
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Gatto L, Di Nunno V, Franceschi E, Tosoni A, Bartolini S, Brandes AA. Pharmacotherapeutic Treatment of Glioblastoma: Where Are We to Date? Drugs 2022; 82:491-510. [PMID: 35397073 DOI: 10.1007/s40265-022-01702-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
The clinical management of glioblastoma (GBM) is still bereft of treatments able to significantly improve the poor prognosis of the disease. Despite the extreme clinical need for novel therapeutic drugs, only a small percentage of patients with GBM benefit from inclusion in a clinical trial. Moreover, often clinical studies do not lead to final interpretable conclusions. From the mistakes and negative results obtained in the last years, we are now able to plan a novel generation of clinical studies for patients with GBM, allowing the testing of multiple anticancer agents at the same time. This assumes critical importance, considering that, thanks to improved knowledge of altered molecular mechanisms related to the disease, we are now able to propose several potential effective compounds in patients with both newly diagnosed and recurrent GBM. Among the novel compounds assessed, the initially great enthusiasm toward trials employing immune checkpoint inhibitors (ICIs) was disappointing due to the negative results that emerged in three randomized phase III trials. However, novel biological insights into the disease suggest that immunotherapy can be a convincing and effective treatment in GBM even if ICIs failed to prolong the survival of these patients. In this regard, the most promising approach consists of engineered immune cells such as chimeric antigen receptor (CAR) T, CAR M, and CAR NK alone or in combination with other treatments. In this review, we discuss several issues related to systemic treatments in GBM patients. First, we assess critical issues toward the planning of clinical trials and the strategies employed to overcome these obstacles. We then move on to the most relevant interventional studies carried out on patients with previously untreated (newly diagnosed) GBM and those with recurrent and pretreated disease. Finally, we investigate novel immunotherapeutic approaches with special emphasis on preclinical and clinical data related to the administration of engineered immune cells in GBM.
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Affiliation(s)
- Lidia Gatto
- Department of Oncology, AUSL Bologna, Bologna, Italy
| | | | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy.
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
| | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
| | - Alba Ariela Brandes
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
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17
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Stewart J, Sahgal A, Chan AKM, Soliman H, Tseng CL, Detsky J, Myrehaug S, Atenafu EG, Helmi A, Perry J, Keith J, Jane Lim-Fat M, Munoz DG, Zadeh G, Shultz DB, Das S, Coolens C, Alcaide-Leon P, Maralani PJ. Pattern of Recurrence of Glioblastoma Versus Grade 4 IDH-Mutant Astrocytoma Following Chemoradiation: A Retrospective Matched-Cohort Analysis. Technol Cancer Res Treat 2022; 21:15330338221109650. [PMID: 35762826 PMCID: PMC9247382 DOI: 10.1177/15330338221109650] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: To quantitatively compare the recurrence
patterns of glioblastoma (isocitrate dehydrogenase-wild type) versus grade 4
isocitrate dehydrogenase-mutant astrocytoma (wild type isocitrate dehydrogenase
and mutant isocitrate dehydrogenase, respectively) following primary
chemoradiation. Materials and Methods: A retrospective matched
cohort of 22 wild type isocitrate dehydrogenase and 22 mutant isocitrate
dehydrogenase patients were matched by sex, extent of resection, and corpus
callosum involvement. The recurrent gross tumor volume was compared to the
original gross tumor volume and clinical target volume contours from
radiotherapy planning. Failure patterns were quantified by the incidence and
volume of the recurrent gross tumor volume outside the gross tumor volume and
clinical target volume, and positional differences of the recurrent gross tumor
volume centroid from the gross tumor volume and clinical target volume.
Results: The gross tumor volume was smaller for wild type
isocitrate dehydrogenase patients compared to the mutant isocitrate
dehydrogenase cohort (mean ± SD: 46.5 ± 26.0 cm3 vs
72.2 ± 45.4 cm3, P = .026). The recurrent gross
tumor volume was 10.7 ± 26.9 cm3 and 46.9 ± 55.0 cm3
smaller than the gross tumor volume for the same groups
(P = .018). The recurrent gross tumor volume extended outside
the gross tumor volume in 22 (100%) and 15 (68%) (P= .009) of
wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients,
respectively; however, the volume of recurrent gross tumor volume outside the
gross tumor volume was not significantly different (12.4 ± 16.1 cm3
vs 8.4 ± 14.2 cm3, P = .443). The recurrent gross
tumor volume centroid was within 5.7 mm of the closest gross tumor volume edge
for 21 (95%) and 22 (100%) of wild type isocitrate dehydrogenase and mutant
isocitrate dehydrogenase patients, respectively. Conclusion: The
recurrent gross tumor volume extended beyond the gross tumor volume less often
in mutant isocitrate dehydrogenase patients possibly implying a differential
response to chemoradiotherapy and suggesting isocitrate dehydrogenase status
might be used to personalize radiotherapy. The results require validation in
prospective randomized trials.
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Affiliation(s)
- James Stewart
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Ali Helmi
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Perry
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Pathology, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - David B Shultz
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Coolens
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Department of Medical Imaging, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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